ABSTRACT
Since COVID-19 was first reported, different neurological complications have been acknowledged, but their description is constantly evolving. We report a case of concurrent tonic pupil and trochlear nerve palsy in this context. A 62-year-old man reported a 5-day history of binocular vertical diplopia and blurred vision in his left eye, noticing that his left pupil was dilated. He had suffered a flu-like syndrome 2 weeks before. Clinical exam showed a right trochlear nerve palsy and a left mydriatic pupil. MRI, X chest ray, and analytical results were normal. Antibodies for SARS-CoV-2 were positive (low IgM and high IgG titers). Antiganglioside antibodies were negative. A 0.125% pilocarpine test confirmed Adie's pupil diagnosis. The patient was treated with a tapered prednisone dose with resolution of his diplopia but no change in Adie's pupil. This is the first case reporting Adie's pupil as a postinfectious manifestation of COVID-19. An immune-mediated mechanism is presumed.
Subject(s)
COVID-19/complications , Tonic Pupil/virology , Trochlear Nerve Diseases/virology , Anti-Inflammatory Agents/therapeutic use , Diplopia/drug therapy , Diplopia/virology , Humans , Male , Middle Aged , Prednisone/therapeutic use , SARS-CoV-2 , Tonic Pupil/drug therapy , Trochlear Nerve Diseases/drug therapySubject(s)
Cranial Nerve Diseases/diagnosis , Eye Infections, Viral/diagnosis , Herpes Zoster Ophthalmicus/diagnosis , Ocular Motility Disorders/diagnosis , Orbital Diseases/diagnosis , Abducens Nerve Diseases/diagnosis , Abducens Nerve Diseases/drug therapy , Abducens Nerve Diseases/virology , Acyclovir/therapeutic use , Aged , Antiviral Agents/therapeutic use , Cranial Nerve Diseases/drug therapy , Cranial Nerve Diseases/virology , Epithelium, Corneal/pathology , Eye Infections, Viral/drug therapy , Eye Infections, Viral/virology , Female , Glucocorticoids/therapeutic use , Herpes Zoster Ophthalmicus/drug therapy , Herpes Zoster Ophthalmicus/virology , Humans , Male , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/virology , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/drug therapy , Oculomotor Nerve Diseases/virology , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/drug therapy , Optic Nerve Diseases/virology , Orbital Diseases/drug therapy , Orbital Diseases/virology , Prednisolone/therapeutic use , Trigeminal Nerve Diseases/diagnosis , Trigeminal Nerve Diseases/drug therapy , Trigeminal Nerve Diseases/virology , Trochlear Nerve Diseases/diagnosis , Trochlear Nerve Diseases/drug therapy , Trochlear Nerve Diseases/virologyABSTRACT
Herpes zoster ophthalmicus can be associated with a variety of ocular and visual sequelae, including isolated or even multiple cranial neuropathies, potentially affecting the oculomotor, trochlear, or abducens nerves. We report a case of a secondary Brown syndrome following resolution of a unilateral isolated trochlear nerve palsy associated with herpes zoster ophthalmicus in an immunocompetent 57-year-old man.
Subject(s)
Herpes Zoster Ophthalmicus/drug therapy , Ocular Motility Disorders/virology , Strabismus/virology , Trochlear Nerve Diseases/virology , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Humans , Male , Middle Aged , Trochlear Nerve Diseases/drug therapyABSTRACT
Ocular motor cranial nerve palsies of viral etiology are uncommon and, when accompanied by skin lesions, zoster ophthalmicus is the most frequent diagnosis. We describe the case of a 68-year-old woman who developed fourth and sixth nerve palsies 3 days after appearance of a painful vesicular skin rash on the left side of her forehead. Neuroimaging was normal but polymerase chain reaction (PCR) testing of the cerebrospinal fluid was positive for Herpes Simplex 1 and negative for Varicella Zoster. The patient was treated with intravenous acyclovir, and the cranial nerve palsies resolved over 7 weeks. Although the similarity of the cutaneous vesicular eruption in our patient to that seen with zoster might have led to an incorrect diagnosis, acyclovir seems to be safe and effective for both viral etiologies.
Subject(s)
Abducens Nerve Diseases/etiology , Herpes Simplex/complications , Herpesvirus 1, Human/pathogenicity , Trochlear Nerve Diseases/etiology , Trochlear Nerve Diseases/virology , Abducens Nerve Diseases/virology , Aged , Female , HumansSubject(s)
Influenza B virus , Influenza, Human/complications , Influenza, Human/physiopathology , Oculomotor Nerve Diseases/virology , Trochlear Nerve Diseases/virology , Adult , Antiviral Agents/therapeutic use , Blepharoptosis/virology , Humans , Influenza, Human/drug therapy , Male , Oseltamivir/therapeutic useABSTRACT
PURPOSE: To report central nervous system involvement after varicella zoster virus infection. METHODS: We evaluated the frequency and type of neurological complications in patients initially presenting with ophthalmic herpes zoster at an ophthalmological department in a Danish university hospital, over a 7-year period. RESULTS: Of the 110 immunocompetent patients who presented with initial ophthalmic zoster, six (5.5%) suffered from neurological complications other than post-herpetic neuralgia. Four experienced isolated cranial motor nerve palsies, one patient had meningitis with a favourable outcome and one patient had severe encephalitis with a poor clinical outcome. CONCLUSIONS: Central nervous system involvement after varicella zoster virus infection is an uncommon, but potentially life-threatening, complication. Early recognition of neurological complications prompts acute, appropriate antiviral treatment.
